Heart Failure Outcomes Among Medicare Beneficiaries Before and During the COVID-19 Pandemic

Heart failure (HF) disproportionately affects older adults, and the COVID-19 public health emergency coincided with substantial changes in health care utilization in the United States. Using Centers for Medicare & Medicaid Services Medicare Fee-For-Service data, we examined national trends in HF hospitalizations, risk-adjusted 30-day mortality, and 30-day readmissions from January 2017 through December 2021 among beneficiaries aged ≥65 years. Prepandemic data from 2017-2019 were used to train Auto-Regressive Integrated Moving Average models to project expected outcomes during the pandemic period, enabling estimation of excesses or deficits relative to observed values. Among 2,209,153 HF hospitalizations, the median age-adjusted hospitalization rate declined from 134.5 per 100,000 person-years before March 2020 to 101.0 per 100,000 person-years during March 2020-December 2021, corresponding to an average monthly deficit of 33.5 per 100,000 person-years. The median risk-adjusted 30-day mortality rate declined from 12.9% to 12.5%, and the median risk-adjusted 30-day readmission rate declined from 21.5% to 21.4%. These differences were observed nationally and extended beyond the early pandemic period. In conclusion, HF hospitalizations, 30-day mortality, and 30-day readmissions among Medicare beneficiaries declined during the COVID-19 pandemic relative to expected pre-pandemic trends.